Medicare Part B Therapy While Living in a Nursing Home: Questions to Ask
A resident can live in a nursing home long-term without being in a Medicare Part A-covered skilled nursing stay.
In that situation, Medicare Part B may still cover medically necessary doctor visits and outpatient physical, occupational, or speech-language therapy when coverage requirements are met.
Separate the resident’s housing/payment status from the therapy benefit.
Ask whether Part A is covering the stay
First ask:
- Is the resident currently in a Medicare Part A SNF benefit period?
- Has Part A skilled coverage ended?
- Is the resident now private pay, Medicaid, or another long-term-care arrangement?
The therapy billing path changes with the setting/payment period.
Part B can cover outpatient therapy
Medicare says Part B covers medically necessary outpatient physical therapy, and Medicare’s nursing-home coverage page specifically notes that Part B can cover doctor visits and PT/OT/speech therapy even while a person lives in a nursing home.
Coverage still depends on the therapy being medically necessary and meeting Medicare rules.
Ask who furnishes and bills the therapy
The nursing home may have:
- in-house therapy staff;
- a contracted therapy company; or
- another provider arrangement.
Ask:
- Who is the billing provider?
- Is the provider enrolled in Medicare?
- Is the service billed under Part B?
- What coinsurance applies?
- Does Medigap/secondary coverage apply?
Maintenance therapy can qualify when skilled
CMS’s Jimmo guidance applies to outpatient therapy too.
Improvement is not required when skilled therapy is needed to maintain function or prevent/slow decline and other coverage criteria are met.
Do not confuse covered therapy with custodial care
Part B therapy coverage does not pay the nursing home’s long-term room-and-board or custodial care charge.
Those are separate expenses.
Part B therapy worksheet
Long-term residence payer: ____________________
Part A SNF coverage active?: Yes / No
Therapy discipline: ____________________
Ordering/certifying provider: ____________________
Therapy billing provider: ____________________
Medicare Part B confirmed: ____________________
Coinsurance/secondary coverage: ____________________
Goal: improve / maintain / slow decline: ____________________
Frequently asked questions
Is there an annual therapy dollar cap?
Medicare’s current PT coverage page says there is no limit on how much Medicare pays for medically necessary outpatient therapy in a calendar year, though documentation/review requirements may still apply.
Does Medicaid room-and-board status stop Part B therapy?
Not automatically; Medicare and Medicaid can cover different services. Verify the individual billing arrangement.
Does therapy need to show improvement?
No improvement-only rule applies; skilled maintenance can qualify.
The practical goal
For a long-term nursing-home resident, ask two separate questions:
Who pays for residence?
and
Does Medicare Part B cover this medically necessary therapy service?
Related NHP guides
- Physical, Occupational, and Speech Therapy in Rehab: Who Helps With What?
- What Happens When Medicare Stops Paying for Rehab?
Primary sources checked
*Editorial/source review: October 15, 2026. General education only. Coverage, billing, DME, home-health eligibility, network status, and claim responsibility must be verified against the beneficiary’s actual Medicare/plan documents.*
